Extended Time Window Mechanical Thrombectomy for Acute Stroke in Brazil

Area of Science:

• Neurology
• Interventional Neurology
• Public Health

Background:

• Mechanical thrombectomy (MT) is a standard treatment for acute ischemic stroke (AIS) due to large vessel occlusion within 6 hours.
• Extended MT windows up to 24 hours are established, but outcomes in developing countries remain largely unknown.

Purpose of the Study:

• To evaluate the safety and efficacy of mechanical thrombectomy for AIS in Brazil, specifically for patients treated beyond the initial 6-hour window.
• To assess outcomes in a Latin American developing country context.

Main Methods:

• Retrospective review of AIS patients treated with MT beyond 6 hours (2015-2018) at a Brazilian public hospital.
• Inclusion criteria: anterior circulation large vessel occlusion (internal carotid artery/proximal middle cerebral artery).
• Assessment of CT Perfusion mismatch (RAPID® software), modified Rankin Scale (mRS), mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days.

Main Results:

• Fifty-four patients were analyzed (mean age 65.6 years, 55.6% male).
• Successful recanalization (TICI 2b-3) was achieved in 92.6% of patients.
• Good functional outcome (mRS ≤2) was observed in 34%, with a 20.3% mortality rate and 11.1% sICH rate.

Conclusions:

• Mechanical thrombectomy for AIS beyond 6 hours can be performed safely in a developing country setting like Brazil.
• The study demonstrates adequate functional outcomes, supporting extended MT windows in Latin America.
• Further research is needed to identify and overcome barriers to widespread MT implementation in the region.